A absolute of 739 accouchement with HIV acknowledgment in utero had completed at atomic 1 Wechsler assay and were advised acceptable for this assay (Figure, Supplemental Digital Content 1, http://links.lww.com/INF/B920). The numbers of assessments were: WPPSI-III (n = 369), WASI (n = 452) and WIAT-II-A (n = 451). Some accouchement (n = 216) were advised disqualified for the analyses because they had a abstraction appointment at which 1 or added Wechsler tests were accepted to be administered but were not. The affidavit for this were primarily that the assay could not be completed in English, abridgement of time or scheduling problems. Of the acceptable assessments, 3 WPPSI-IIIs were accepted invalid and afar from the analysis. In addition, 83 accouchement who completed both a WPPSI-III and a WASI assay were afar from the sample for WASI analysis, because this assay acclimated abandoned the aboriginal cerebral appraisal for anniversary child. Of the accouchement with a accurate cerebral or bookish assessment, 26 added accouchement after accessible prenatal ARV abstracts were excluded, as follows: WPPSI-III, n = 5 (1.4%); WASI, n = 9 (2.4%) and WIAT-II-A, n = 12 (2.7%). The final sample admeasurement for assay was WPPSI-III, n = 361; WASI, n = 360 and WIAT-II-A, n = 439. There were some cogent differences in demographic characteristics amid accouchement who were included in the analyses against those who were not included. For all 3 outcomes, the differences were associated primarily with the child’s race, ethnicity and primary accent (P≤0.001).
Several of the demographic characteristics of the sample included in this abstraction (Table, Supplemental Digital Content 2, http://links.lww.com/INF/B921) are of note. The admeasurement of preterm births (<37 weeks) ranged from 17–21% and low bearing weight (<2500 g), 18–20%. Additionally, 59–69% of the accouchement lived in households with ≤$20,000 anniversary income. Approximately, one-third of the caregivers had beneath than a aerial academy apprenticeship and 9–10% had a FSIQ of <70.
Among the WPPSI-III sample, 97% of accouchement were apparent in utero to some blazon of ARV; 81% were apparent to cARV and 66% to a PI-containing cARV regimen. In the WASI sample, 93% were apparent in utero to some blazon of ARV; 60% to cARV and 45% to a PI-containing cARV regimen. In the WIAT-II-A sample, 94% were apparent in utero to some blazon of ARV; 63% to cARV and 47% to a PI-containing cARV regimen. Regarding neonatal prophylaxis, 91% of the WPPSI-III sample, 86% of the WASI sample and 87% of the WIAT-II-A sample were apparent to zidovudine alone. In anniversary sample, abandoned 1% accustomed no neonatal ARV prophylaxis.
Unadjusted WPPSI-III, WASI and WIAT-II-A array are presented in Figure 1. The beggarly array were decidedly beneath citizenry norms (P = 0.01 to P < 0.001) with the barring of the WASI VIQ (P = 0.48), yet these beggarly array (ranging from 93 to 99) still fell aural the accepted ambit for the children’s ages.
Figure 1.
Unadjusted beggarly cerebral and bookish array with 95% aplomb limits.
By Prenatal ARV Regimen. Table 1 presents the adapted beggarly cerebral and bookish array for anniversary prenatal ARV regimen. The agency were adapted for the amount confounders apparent in the table note. No cogent differences in adapted beggarly array were empiric amid the groups apparent prenatally to cARV against non-cARV regimens. There were no cogent differences in beggarly array for any cerebral or bookish aftereffect back comparing NNRTI-based cARV regimens and non-cARV regimens with PI-based cARV regimens. No cogent differences were begin back comparing outcomes for accouchement not apparent to any PI with those apparent to additional or non-boosted PIs. In addition, no cogent associations were empiric amid the accumulative continuance (in months) of prenatal cARV acknowledgment and cerebral and bookish outcomes.
By Prenatal Acknowledgment to Abandoned ARVs. No abandoned ARV was associated with decidedly lower beggarly cerebral or bookish outcomes. However, prenatal acknowledgment to regimens absolute tenofovir (Viread; Gilead Sciences, Inc., Foster City, CA) was associated with college beggarly WPPSI-III PIQ array compared with regimens after tenofovir (100.8 against 96.1, P = 0.03; Table 2).
By Neonatal Exposure. Many accouchement accustomed zidovudine alone; abandoned 46 (13%) and 52 (12%) of the WASI and WIAT-II-A samples, respectively, were apparent to aggregate neonatal prophylaxis. Accouchement who accustomed zidovudine in aggregate with addition ARV during the aboriginal 8 weeks of activity had decidedly college WASI VIQ and WIAT-II-A Word Reading and Spelling array (by 6.4–8.3 points) back compared with accouchement who accustomed zidovudine alone.
Sensitivity Analyses. Acuteness analyses including prematurity and low bearing weight in the adapted models resulted in agnate adapted furnishings of ARV regimen, cARV exposure, abandoned ARVs and neonatal prophylaxis on cerebral and bookish outcomes. A cogent affiliation of in utero acknowledgment to zidovudine or to zidovudine/lamivudine (Combivir; GlaxoSmithKline, Brentford, Middlesex, United Kingdom) with lower WPPSI-III VIQ was observed; these allegation were not empiric in the primary analysis.
The after-effects of acuteness analyses including assay armpit in the adapted models were agnate to the after-effects of the primary analyses. The cogent affiliation of tenofovir with college WPPSI-III PIQ was attenuated. Acknowledgment to didanosine (Videx; Bristol-Myers Squibb, New York, NY) was decidedly associated with lower WASI VIQ; this aftereffect was not empiric in the primary analysis.
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